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15th Annual Conference POSTERPRESENTATIONS Clinical or Product Innovation W Nurse Clinielatl Effectiveness ill a VA Medical Center Patricia K. Miller, BSN Marilou 'avarro, Ri\! San Francisco, CA Purpose/Objectives: Demonstrate that an IV Nurse Clinician program improves vascular access patient care through inser- tion of PICCs and midlines, and with cen- tral and peripheral access monitoring. Specific objectives (Q improve patient out- comes and realize cost savings <Ire to decrease 1) accidental PICC dislodgement; 2) imcrventional mdiology Pice insertions; and 3) line associated bacteremia rates, Background/Significance: TI,e downsiz- ing of the early 90s resulted in the elimina- tion of most IV Teams. There are over 200,000,000 vascular access devices used per year. Approximately 500,000 deviee- associated bacetermia'i occur per Ye'dr. TIle esumated COSl of e'd.ch baceteremia ranges from 55,000 to 532,000. Procedures for data collection: Data collection involved an IV Nurse Clinician- created N documentation program in the hospital's electronic computer system. The program tracking methodology utilizes catheter days to evaluate venous access. Data are entered into the IV documenla- tion program by the nursing staff. and then downloaded to Excel for analysis. Results: 1) Accidental PICC line dis- lodgemem decreased after initialion of suture securement, from 0.4 in 1999 (Q 0.1 in 2000. 2) PICC line insertions in inter- ventional radiolq;.ry decreased from 26% in 1996 to 15% in 2000. 3) Line associated bacteremia rates decreased from 55 in 1995 to 0.5 in 2000. Implication for practice, Specially trained nurses provide patients with improved venous access care through Pice and midline insertions and improved track- ing Hospitals strongly benefit from an IV Nurse Clinician Program with improved patient C'Me and cost savings. Clinical or Product Innovation A Decisio"-Maki"g Tool to Mi"j- mlze ItUlpproprlate GatlJeter Removal Janice Gabriel Portsmouth, Hampshire, UK In 1995 Peripherally Inserted Central Catheters (PICCs) were introduced into clinical practice in the United Kingdom (UK). At that time, PICes were a new clin- ical development in the UK, so no prece- dent had been established as to which group of health care professionals should assume responsibility for the placement and management of t11esc devices. During the past five yeJrs nurses have proved their skill and expenise in placing PICCs, and it is now accepted that this is a nurse-led practice. With increasing numbers of PICC placements taking place in hospi- tals throughout the UK. many non-special- ist nurses, on general wards and in patients' homes, are now having to take on the resrxmsibility for the managcment of these devices. This has resulted in t11e aut110r wit- nessing an ina'ease in the number of PICes being removed on the grounds that t.hey are 'no longer patent'. To address dlis prob- lem the author has developed a making tool to facilitate colleagues to identify the possible cause(s) of an occluded PICC and remedial aaion dlat can be taken. "'his paper will iIIustrJle dle deci- sion-making t.ool used. (Since the tool was first produced it has now been shared and developed with colleagues in the GIDshong PICC Placers Group). Clinical or Pr'oduct Innovation lmporlallce oj Nursillg Assessment witlJ Patiellts Ij'}illJ Implalltable Ports Pamela A. Sal )arino-Holmes Miami, FI Implantable pons are used for dle deliv- elY of hydration, antibiotics, parenteral nutrit.ion, 'chemothepeutic agcnLli and blcxx:l products. \Vhile [here are numerous factors to consider when selecting a vascular access device for an individual patient, awareness of potentia I problems with the access device are perhaps more important ro patient safely and JX'sitive outcomes. The initiat.ion of this snldy started in May 2000 after an oncologist office prac- tice nurse C'Jlled to repon severdl pon fail- ures. Chemother::lpy nufSCS werc unable to obtain blood rerum from several patients' implamable pOllS. Al the time there were no patient names or idte of occurrences. In order to obtain a denominator for the number of ports placed or pon checks taking place, a list of all lJOlt cheeks com- pleted October 1998 and May 2000 was requested. In reviewing medical records for these pariems, it was discovered that POlt fraaures were a problem. Of 136 IJOlt checks there were 36 ti'acUired catheters, 32 pons with thrombus/fibrin occlUSions, and 20 were listed as "c1avicle pinch off syndrome" in t11e dictations of t.he proce- dures by the interventional radiologists. Because of the implications of.a pon fmc- nlre to a patient receiving chemotherapy, a more intensive review was initiated. Findings: WI>ile thrombus/fibrin sheath is often anticipated as the cause of a mal- functioning POlt, the clinician should never 20 .JVAD S p r n g 2002
Transcript
Page 1: 15th Annual Conference: Poster Presentations

15th Annual ConferencePOSTERPRESENTATIONS

Clinical orProduct

Innovation

W Nurse Clinielatl Effectiveness illa VA Medical Center

Patricia K. Miller, BSNMarilou 'avarro, Ri\!San Francisco, CA

Purpose/Objectives: Demonstrate thatan IV Nurse Clinician program improvesvascular access patient care through inser­tion of PICCs and midlines, and with cen­tral and peripheral access monitoring.Specific objectives (Q improve patient out­comes and realize cost savings <Ire todecrease 1) accidental PICC dislodgement;2) imcrventional mdiology Pice insertions;and 3) line associated bacteremia rates,

Background/Significance: TI,e downsiz­ing of the early 90s resulted in the elimina­tion of most IV Teams. There are over

200,000,000 vascular access devices usedper year. Approximately 500,000 deviee­associated bacetermia'i occur per Ye'dr. TIle

esumated COSl of e'd.ch baceteremia rangesfrom 55,000 to 532,000.

Procedures for data collection: Datacollection involved an IV Nurse Clinician­created N documentation program in thehospital's electronic computer system. Theprogram tracking methodology utilizescatheter days to evaluate venous access.Data are entered into the IV documenla­tion program by the nursing staff. andthen downloaded to Excel for analysis.

Results: 1) Accidental PICC line dis­lodgemem decreased after initialion ofsuture securement, from 0.4 in 1999 (Q 0.1in 2000. 2) PICC line insertions in inter­ventional radiolq;.ry decreased from 26% in1996 to 15% in 2000. 3) Line associatedbacteremia rates decreased from 55 in1995 to 0.5 in 2000.

Implication for practice, Specially

trained nurses provide patients withimproved venous access care through Piceand midline insertions and improved track­ing Hospitals strongly benefit from an IVNurse Clinician Program with improvedpatient C'Me and cost savings.

Clinical orProduct

Innovation

A Decisio"-Maki"g Tool to Mi"j­mlze ItUlpproprlate GatlJeterRemoval

Janice GabrielPortsmouth, Hampshire, UK

In 1995 Peripherally Inserted CentralCatheters (PICCs) were introduced intoclinical practice in the United Kingdom(UK). At that time, PICes were a new clin­ical development in the UK, so no prece­dent had been established as to whichgroup of health care professionals shouldassume responsibility for the placementand management of t11esc devices.

During the past five yeJrs nurses haveproved their skill and expenise in placingPICCs, and it is now accepted that this is anurse-led practice. With increasing numbersof PICC placements taking place in hospi­tals throughout the UK. many non-special­ist nurses, on general wards and in patients'homes, are now having to take on theresrxmsibility for the managcment of thesedevices. This has resulted in t11e aut110r wit­nessing an ina'ease in the number of PICesbeing removed on the grounds that t.heyare 'no longer patent'. To address dlis prob­lem the author has developed a decision~

making tool to facilitate colleagues toidentify the possible cause(s) of anoccluded PICC and remedial aaion dlat canbe taken. "'his paper will iIIustrJle dle deci­sion-making t.ool used. (Since the tool wasfirst produced it has now been shared and

developed with colleagues in the GIDshongPICC Placers Group).

Clinical orPr'oduct

Innovation

lmporlallce ojNursillg AssessmentwitlJ Patiellts Ij'}illJ Implalltable Ports

Pamela A. Sal )arino-HolmesMiami, FI

Implantable pons are used for dle deliv­elY of hydration, antibiotics, parenteralnutrit.ion, 'chemothepeutic agcnLli and blcxx:lproducts. \Vhile [here are numerous factorsto consider when selecting a vascular accessdevice for an individual patient, awarenessof potentia I problems with the accessdevice are perhaps more important ropatient safely and JX'sitive outcomes.

The initiat.ion of this snldy started inMay 2000 after an oncologist office prac­tice nurse C'Jlled to repon severdl pon fail­ures. Chemother::lpy nufSCS werc unable toobtain blood rerum from several patients'implamable pOllS. Al the time there wereno patient names or idte of occurrences.In order to obtain a denominator for thenumber of ports placed or pon checkstaking place, a list of all lJOlt cheeks com­pleted October 1998 and May 2000 wasrequested. In reviewing medical recordsfor these pariems, it was discovered thatPOlt fraaures were a problem. Of 136 IJOltchecks there were 36 ti'acUired catheters,32 pons with thrombus/fibrin occlUSions,and 20 were listed as "c1avicle pinch offsyndrome" in t11e dictations of t.he proce­dures by the interventional radiologists.Because of the implications of.a pon fmc­nlre to a patient receiving chemotherapy,a more intensive review was initiated.

Findings: WI>ile thrombus/fibrin sheathis often anticipated as the cause of a mal­functioning POlt, the clinician should never

20 .JVAD S p r n g 2 0 0 2

Page 2: 15th Annual Conference: Poster Presentations

assume thar this is the only problem. Ourstudy found an equally high number offractured catheters which can C'Juse severeproblems for the oncology patient such asan extravasation. Since patients are velYdependent on a fully functioning POlt fortheir care, it is vital that the clinician inves­tigate possible reasons and request a con­sull lO determine the tme reason for themalfunction.

Conclusion:A pon withollt a blood return should

not be lIsed since there can be a factureor a thrombus - both cases require expertintervention to determine the cause of themalfunction.

Research

Palielll Preferellces alld Q/lalil)' ofLife Assessme1lt ill all Outpatie1lt Par­ellteral Antibiotic Therapy Program

Allan Goodfellow, BSC (Pharm)Amy O. \XIai, BSC (Phann)Carlo A. Marra, BSC (Pharm), PI1<1rmDLuciana Ftigheno, SC (Pharm), FCSIiPBarb Ferreira, BSN, C[NA(c)Carole Leong, BSNRuth Nicol, BSNLynn Chase, IlSN, ClNA(c)Sally Tomlinson, BNPeter J. jewesson, PhD, FCSHPVancouver, DC

Objectives: To elicit treaunem locationpreferences from Outpatient ParenteralAntibiotic Thempy (OPAT) prow"m ("ndi­dates and to measure changes in quality oflife (QOL) for enrollees into dle prog'''m.

Methods: A multidisciplinary, prospec­tive study was conducted at VancouverGeneral Hospital, a lOOO-bed tertialY careinstitution. This study involved contingemvaluation [willingness-to-pay (WTP)] andQOL questionnaires administered during a9-monrh study period. Eligible and con­senting adult patients who were referredto the OPAT program were asked to com·plete the \VTP questionnaire. Patients sub­sequently enrolled in the program wereconsidered eligible for the QOL assess­ment and completed a Sholt Form-36 (SF­36) questionnaire within 48 hours of

discharge and repeated at 26-30 days.Results: Ninety-one patients were

enrolled in the \VIl' pan of dlis study. Ofthese, 77 (85%) patients repolted a prefer­ence for treatment in the home settingwillie 10 (11%) patients preferred to remainin dle hospicd and 4 patients (4%) had nopreference. For those who preferred treat·mem al home, the mean \VTP was $820CDN compared to a mean WT" of £873CON for those who preferred to ren1<1in inthe hospital. Sevenry·four patients com­pleted the QOL assessment. While role­physical and gene"i1 healdl QOL domainscores tended to decline, bodily pain, socialfunctioning and role-emotional scorestended to improve subsequem to discharge.

Conclusion: This study reveals thattreatmem at home is preferred by mostinpatients receiving intravenous amibiolictherapy and preliminary assessment sug­gesls an improvement in certain QOLdomains for those who ~Ire enrolled intoan OPAT program.

Research

p,.o~pecUve RllPldolllized eompari·SOil ofThree Needleless COllnectorswit" a PICC

Douglas Buehrle, RNDurham, NC

A challenge is presented to the intra­venous clinician in an effon to maimaincatheter patency in a variety of patient caresettings. Finding a valve that is affordableand functional to help prevent cadleterocclusion is dle plllpose of dlis comparisonsrudy. Not onJy have \Ve compared differ­ent valves bUl also tJleir actual function toprevent clots related to the pump occlu­sions, kinked tubing, effects of positivepressure flushing and dry IV bags. Ourstudy group included 200 patients withPICC lines. 11ley valied in age flDm 1 weekto dle elderly. TI,e valves evaluated for dlisstudy include the PASV vatve, the CLC2000,and a swabable dave. I'ICC lines used were1.9 FR. to 5 FR. cadleters. Most of the PICClines placed were 3 FR. open-endedcatheters. Standardized Oushing protocolswere used in this comparison, using both

saline and heparin. A few of dle PASV valvepatients reponed using saline only flushesin the home setting with a Q24-hollf flushprotocol. TI,e author repons signifiarnt find­ings and differences among the variedvalves studied in this trial. His findingsshowed signiAclt11: cost and time savingIxnh 10 his clepa rtment and institution.Results of dlis study showed a lOO!o occlu­sion rate for the patients using a standarddave and positive pressure flushing tech·niquel a 4% occlusion rate when using theCLC2000, and < ] % occlusion rate whenusing the PASV valve. AJthough no otherevc C'Jdleters wete evaluated in dlis study,it is the opinion of the author that d1eresulLs would remann the same.

Resiearch

~mIDII

Impact ofcatheter Dec/usiolls illHomecare

Susan Poole, BSN, MS, CRNI, CNSNNancy Moureau, BSN, CRNILibertyville, IL

Catheter occlusion is one of dle most fre­quently occurring complications and is apartiullar issue in homec-Jre. These patienLsare often on long-term therapies and mayneed central venous access for extendedperiods of time. Urokinase was dle drug ofchoice for catheter de'Jrance in home care.\Vhen Urokinase ceased to be available dleimpact was realized by patients at homeand the homecare companies proViding ser­vices. A retrospective study regarding theimpact on patiem care and economics ofcatheter occlusion was done on proVidersin the homecare setting. Data from infusionproviders in 37 states were colleded by athird party Olllcomes vendor. Analysis of50,750 catheters .in homecare patientsreponed 2,339 occurrences of loss ofpatency, widl 647 attributed to loss ofpatency due to cadleter dltombosis. Signifi­cant COS15 associated with provision of ser­vice such as a homecare visil andreplacemenr of the line were sllI1unarized.Awareness of the costs, exploring medlO<Isto prevent occlusion and alternatives inmanagement afe critical elements inimproving patient care ..md Outcomes. •

Spr ng 2002 .JVAC 21

Page 3: 15th Annual Conference: Poster Presentations

Summary of NAVAN Annual Conference Evaluatiions

1997 through 2001(% Positive Responses to Topics)

Question I Topic 1997 1998 1999 20 o 2001Philadelphia San Diego Orlando San IDiego Alexandria

Overall Impression 91% 100% 99% 10:::>% 98%

Educational Programs

Relevant to practice 100% 100% 100% 10:::>% 100%

Current information 91% 100% 99% ~'9% 100%

Ample time allotted 100% 97% 94% ~'6% 96%

Speakers knowledgeable 97% 100% 99% 10t:::>% 100%

Handouts

Program Book comprehensive 100% 100% 99% 98% 96%

Program Book organized 98% 99% 99% ~'4% 94%

Handouts consistent 98% 97% 97% 5'5% 91%

Sufficient handouts 91% 82% 90% 5'4% 76%

Registration

Timely brochure 95% 97% 95% 5% 99%

Complete brochure 91% 98% 98% 1'9% 97%

Registration easy/efficient 100% 99% 98% ~8% 100%

Desk convenient 100% 100% 100% 10b% 100%

Hours sufficient 98% 100% 99% 49% 98%

Program Organization

Events easy to find 100% 98% 95% ~IO% 96%

Kept on schedule 94% 99% 99% 10lP% 98%

Room clearly marked 100% 99% 100% 89% 97%

Facility

Met expectations 78% 90% 81% 'It % 80%

Hotel registration 89% 88% 94% V% 96%

Hotel service 87% 93% 90% 9'5% 85%

Accommodations 72% 88% 78% 8'9% 82%,I

Meals 72% 91% 83% 8:9% 88%

Exhibit Hall

~~,'. 100% 100% 100% c~ 98%

,o",HlI8t nflllds . 97% 90% 96% !e 92%

Representation of Indusa-y 100% 98% 99% C 99%

22 .JVAC Spring 200 2


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